Minoxidil 5% solution is also used in the treatment of alopecia areata, usually in combination with corticosteroids. Local irritants such as tar and anthralin may help in the treatment of alopecia areata.
Topical immunomodulators may be used for treatment of alopecia areata that occurs predominantly in small patches on the scalp or face. With this treatment, the patch can be maintained stable for a long time, without expanding or recurrence.
Topical immunotherapy is one of the most important treatments of alopecia areata. It is usually applied to extensive forms of alopecia on the scalp. The agents used are diphencyprone and SADBE (squaric acid dibutylester). This treatment causes local sensitisation with these substances, which are applied progressively in increasing concentration. The allergic dermatitis caused in the region reduces the population of lymphocytes in the lesions, giving the hair a chance to grow back. The side effects of this alopecia areata treatment are irritation and enlargement of the regional lymph nodes, and it should not be used in children younger than 10 years old. Its effectiveness reaches 50%.
For the treatment of alopecia areata, PUVA light bath therapy has also been used. The effect of PUVA involves local immunosuppression, which allows the hairs to grow back again. The effectiveness of this treatment is 30% in selected cases. The side effects are burns, irritation, allergic reactions, and an increase in the probability of skin cancer. Treatment of alopecia areata with PUVA cannot be used for patients who are younger than 12 years old. Excimer laser 308 nm, acts also as an immunosuppressant but does not have the side effects of PUVA.
Anti-TNF biological agents have been successfully used to treat alopecia areata, particularly Alopecia Totalis.
Several studies are being conducted to find gene therapy for alopecia areata, and eight genes have been isolated as they are associated with the disease. These genes are also related to other conditions, such as rheumatoid arthritis and type 1 diabetes.
Finally, the use of a hair prosthesis (wig) should be taken into consideration, as it covers extensive forms and helps to improve the patient’s psychology, which is an important factor in the treatment of alopecia areata. Nowadays high-quality prostheses are available with very good aesthetic performance. Wigs can be worn for as long as needed, until the patient regains his own hair.